- A-Line Staffing Solutions (Tampa, FL)
- …and will include 80% travel. Remote role. Will require a driver's license . Member assessments and notes. Complete assessments with members, caregivers, or providers ... of acute care Assist member with filing and resolving complaints and appeals . Required Experience: Bachelor's degree in human services related field; Including but… more
- US Tech Solutions, Inc. (Atlanta, GA)
- …with other internal groups regarding determination status and results (seniors, pharmacists, appeals , etc.). 10% . Identify and elevate clinical inquiries to the ... is preferred, Other Certificates or Licenses (List): Active pharmacy technician license per state requirements, or active national certification. Trainee license… more
- A-Line Staffing Solutions (Haverhill, FL)
- …and will include 80% travel. Remote role. Will require a driver's license . Member assessments and notes. Complete assessments with members, caregivers, or providers ... with electronic medical health records, and Microsoft office programs Valid driver's license Preferred Skills/ Experience: Current state's RN, LCSW, LCPC, LSW, LPC… more
- US Tech Solutions, Inc. (Atlanta, GA)
- …other internal groups regarding determination status and results (seniors, pharmacists, appeals , etc). . Identify and elevate clinical inquiries to the pharmacist ... Skills: . Prior Authorization . Call handling experience. Education: . High School diploma or GED . Active pharmacy tech license required of the state they resist. more
- Lane County (OR)
- …domestic partnerships.Coordinating civil ceremonies.Overseeing the Property Value Appeals Board process.Administering the Archives Program.Developing, administering, ... attached your application will not be considered.Licensing Requirements:Oregon Driver's License ; Professional licensure or certification related to the area… more
- A-Line Staffing Solutions (Tampa, FL)
- …long-term care services . Assist member with filing and resolving complaints and appeals Care Coordinator Requirements Bilingual in Spanish and English 2+ years of ... or LPN/LVN licensure Experience with Electronic Medical records Valid driver's license Care Coordinator Preferred Qualifications Prior Home Health Experience Long… more
- Scripps Health (San Diego, CA)
- …patient population. *Preferred Qualifications:* * Bachelor's degree preferred. * Notary license preferred. * Appeals experience preferred. **Job:** **Business ... of the applications, through to the highest level of appeals while adhering to all policies on fraud/abuse and...Benefits Agency. * Bilingual in Spanish. * CA Driver's License . * Ability to comprehend and apply knowledge of… more
- Texas Health Resources (Arlington, TX)
- …Milliman or InterQual criteria required + Case management experience preferred + Denials and Appeals experience preferred + RN license to practice in the state ... **Clinical Reviews, Denial and Appeals RN** **Work location:** Remote **Work hours:** Monday...contracted agreement. + Tracks, monitors, manage clinical denials and appeals and appeal outcomes for reporting as requested. +… more
- City of Boise (Boise, ID)
- …requirements. Prepares documentation of enforcement actions, including denials, abatements, appeals , or license revocations. Implements suspensions or ... of Code Enforcement (AACE). Prior experience in code enforcement. business license enforcement or planning and zoning. Licensing And Other Requirements Valid… more
- Fallon Health (Worcester, MA)
- …purpose** : Responsible for the coordination and timely completion of provider appeals . Serves as a liaison between Fallon Health and contracted and non-contracted ... providers with appeals regarding filing limit appeals , claim denials,...Bachelor's degree or equivalent combination of training and experience ** License /Certification** N/A **Experience** 2 years related experience, preferably in… more
- Magellan Health Services (San Diego, CA)
- Coordinates appeals process as assigned, attends to risk management issues associated with case management and processes appeal requests. In some cases may be ... medical necessity reviews. + Enters all data related to appeals and case reviews into a database. + Prepares...- Required GED, High School Education - Preferred Associate License and Certifications - Required License and… more
- Motion Recruitment Partners (Durham, NC)
- Clinical Appeals Analyst Durham, NC **100% Remote** Contract $35/hr -...This is a clinical role, need to have a License for 5 years and 3 years of clinical LPN, ... a possible contract to hire opening for a Clinical Appeals Analyst. They have over 4 million customers and...PT, or OT. + Appeals Experience is required **Desired Skills & Experience** +… more
- CVS Health (Hartford, CT)
- …anywhere in the US.**Responsibilities of this Medical Director role are related to Medicare Appeals .* Direct daily work on part C appeals (both provider and ... member/nonparticipating providers) and Part D appeals .* Provide direct support to appeal nurses and dedicated...eg, Clinical Practice or Health Care Industry * Medical License (MD) or (DO)* An Active state medical … more
- Iowa Department of Administrative Services (Des Moines, IA)
- Assistant Attorney General- Criminal Appeals Section Print (https://www.governmentjobs.com/careers/iowa/jobs/newprint/4519255) Assistant Attorney General- Criminal ... Appeals Section Salary $57,636.80 - $139,318.40 Annually Location Des...review, or prior appellate practice. This position requires a license , or the ability to obtain a license… more
- Kepro (Indianapolis, IN)
- … license to practice in the state of Indiana or a Compact license . + Previous healthcare/managed care Appeals experience. + 2+ years of healthcare/managed ... sector. Acentra is currently looking for a Utilization Management Appeals Nurse - LPN/RN to join our growing team....join our growing team. Job Summary: Our Utilization Management Appeals Nurse - LPN/RN will help orchestrate the seamless… more
- Elevance Health (Hendersonville, TN)
- **Nurse Appeals - Licensed Nurse** **Location:** This position will work a hybrid model (remote and office). Ideal candidates will live in the state of Tennessee or ... Louisiana within 50 miles of one of our PulsePoint locations. The **Nurse Appeals ** is responsible for investigating and processing and medical necessity appeals … more
- Elevance Health (Rancho Cordova, CA)
- **Nurse Appeals - Licensed RN Nurse** **Location:** This position will work a hybrid model (remote and office). Ideal candidates will live in the state of California ... locations. **Shift:** Monday to Friday from 8:00-5:00 pm PT The **Nurse Appeals ** is responsible for investigating and processing and medical necessity appeals… more
- LA Care Health Plan (Los Angeles, CA)
- Supervisor, Appeals and Grievances Clinical Operations RN Job Category: Clinical Department: CSC Appeals & Grievances Location: Los Angeles, CA, US, 90017 ... safety net required to achieve that purpose. Job Summary The Supervisor of Appeals and Grievances Clinical Operations (A&G) RN is responsible for executing the… more
- Molina Healthcare (TX)
- …discussed during our interview process._** **JOB DESCRIPTION** **Job Summary** Clinical Appeals is responsible for making appropriate and correct clinical decisions ... for appeals outcomes...ability to easily access and interpret these guidelines. **Required License , Certification, Association** Active, unrestricted State Registered Nursing (RN)… more
- Centene Corporation (Columbus, OH)
- …Ohio **Position Purpose:** Performs clinical reviews needed to resolve and process appeals by reviewing medical records and clinical data to determine medical ... + Communicates with members, providers, facilities, and other departments regarding appeals requests + Generates appropriate appeals resolution communication and… more
